When a man in his late fifties was referred to neurologist Professor Owen White in August 2016 with double vision, facial weakness and an unsteady gait, it appeared he had suffered something akin to a stroke. The reality was even more sinister. A concerted effort by medical teams to pinpoint the mysterious condition as the man’s health progressively failed eventually led to the diagnosis of an exceptionally rare disease – and some lessons for those involved and clinicians beyond. A paper documenting this unusual case appeared recently in the Journal of Clinical Neuroscience.
by Anne Crawford
The patient had originally been diagnosed in hospital with neurological symptoms including double vision, difficulty balancing and stuttering. An MRI scan showed an abnormality in the pons, part of the back of the brain.
However, the man didn’t follow the normal history of stroke. Multiple investigations failed to find an answer to fluctuating, persistent and evolving symptoms.
“Clinically he looked like patients with myasthenia gravis, an immune condition where an antibody is created which blocks conduction from the nerve to muscle. He had changed cranial nerve signs which is always unusual except in myasthenia gravis,” Professor White said.
